No abstract

We have used a computer-based parameter estimation method to obtain peripheral resistance, total arterial compliance, and characteristic resistance from the measurement of aortic pressure and flow in the open-thorax cat, assuming the three-element windkessel as a model of the systemic arterial tree. The method can be applied on a beat-to-beat basis in the steady state and in transients. We have validated this method by analyzing nonsteady-state data obtained from an electrical analog with fixed values of the resistances and compliance and by showing that the values obtained by this procedure were within 5% of the fixed values of the circuit. Changes in total peripheral resistance and arterial compliance were studied before, during, and after acute heart rate changes in five open-thorax cats with blocked autonomous nervous system. As expected, the peripheral resistance, estimated during the heart rate transient [3.93 +/- 0.94 (SE) kPa X ml-1 X s] was the same as before the transient (3.53 +/- 0.83 kPa X ml-1 X s); total arterial compliances were also identical (0.28 +/- 0.04 vs. 0.27 +/- 0.03 ml/kPa). In six cats without nervous blockade we obtained similar results. Calculation of peripheral resistance during transients from the mean pressure-to-mean flow ratio, i.e., without correction for arterial compliance, suggested changes in resistance values of less than or equal to 57%, which shows that correction is necessary. The findings indicate that peripheral resistance and total arterial compliance can be estimated in vivo on a beat-to-beat basis, even during hemodynamic transients.

We tested the hypothesis that the feline left ventricle normally works at optimal external power as opposed to optimal efficiency by (re)analyzing data from five isolated, blood-perfused cat hearts and 39 open-thorax cats. In the isolated hearts, we measured pump function, external steady power, myocardial oxygen consumption, and efficiency. Optimal external power and optimal efficiency were found at different left ventricular outputs (6.94 +/- 0.33 and 8.35 +/- 0.37 ml/s, respectively; P less than 0.001). In the in situ cat hearts the working point was found at an output of 4.72 +/- 0.32 ml/s, whereas optimal external power was found at 4.84 +/- 0.26 ml/s. These values were not significantly different. Assuming that the point of optimal efficiency was located at the same fraction of the maximal unloaded left ventricular output (Fmax) as in the isolated hearts, i.e., 0.7, we found the point of optimal efficiency for the in situ heart at a flow of 5.83 +/- 0.32 ml/s, which was significantly different (P less than 0.001) from the flow in the working point. Our data therefore indicate that the left ventricle in the open-thorax cat is matched to the arterial load such that its external power output rather than efficiency is optimized.

We measured myocardial blood flow (QLVFW) and O2 consumption of the left ventricular free wall (VO2, LVFW) in 13 chronically instrumented, 7-wk-old lambs with an aortopulmonary left-to-right shunt (S) and in 10 control lambs without a shunt (C). The measured VO2, LVFW was compared with the calculated values obtained by two predictive indexes, the rate-pressure product (RPP) and the pressure-work index (PWI). Measured VO2, LVFW in S lambs was significantly higher than in C lambs [983 +/- 104 (SE) vs. 475 +/- 57 mumol X min-1 X 100 g LV-1, P less than 0.001]. This was achieved by the significantly higher QLVFW (294 +/- 33 vs. 145 +/- 15 ml X min-1 X 100 g LV-1, P less than 0.002), since the arteriovenous O2 difference across the left ventricular free wall was similar in both groups of lambs. Total coronary blood flow per unit body mass in S lambs was higher than in C lambs (14.1 +/- 1.5 vs. 5.6 +/- 0.6 ml X min-1 X kg-1, P less than 0.001), not only because of the increased VO2, LVFW per unit muscle mass, but also because of the increased total heart weight (102.4 +/- 6.4 vs. 81.2 +/- 4.9 g, P less than 0.02). Correct estimation of VO2, LVFW by means of the RPP and the PWI was only possible in C lambs. In S lambs the estimated values were significantly lower than the measured ones.(ABSTRACT TRUNCATED AT 250 WORDS)

ABSTRACT. We studied the effect on the circulation of reducing peripheral vascular resistance by infusing sodium nitroprusside into lambs of three different age groups (subgroup A, 11-26 days, subgroup B, 32-52 days, and subgroup C, 61-88 days of age) with and without an aortopulmonary left to right shunt. Infusion of 10 ~g / k g / min nitroprusside over 2 h decreased aortic and left atrial pressures markedly and increased heart rate, whereas systemic, pulmonary, and left to right shunt blood flows hardly changed. Within 30 min after the onset of infusion, the hemodynamic variables stabilized. Aortic and left atrial pressures were still below control levels at that time. The different flows remained the same and heart rate, after an initial fall, increased again. The pattern of hemodynamic changes was not influenced by age or the presence of an aortopulmonary left to right shunt. Based on this study, we do not advocate sodium nitroprusside administration in case of a left to right shunt with normal arterial pressure and systemic blood flow. (Pediatr Res 25:44-48, 1989) Afterload reduction has been widely used in patients with impaired ventricular performance (1, 2). Until recently, experience with afterload reduction in the pediatric age group was limited (3). However, because acute experimental studies first showed the dilatation of systemic resistance vessels diminished the magnitude of a left to right shunt across a ventricular septa1 defect (4), vasodilator treatment of infants with such a defect has become more common (5-7).The results of these studies, however, show no uniformity. This might be a result of the selection of patients or the type of vasodilator used or it might result from the timing of the hemodynamic measurements. The measurements may have been taken before hemodynamic stabilization had set in. This stabilization may take some time, as was shown during the infusion of sodium nitroprusside into lambs without a shunt (8). Consequently, measurement of the instantaneous hemodynamic changes evoked by a vasodilator over a longer period would be preferable. However, in patients this is not feasible.Therefore, we designed the present study with the objectives to examine the changes in pulmonary, systemic, and left to right shunt blood flow caused by sodium nitroprusside in lambs with an aortopulmonary left to right shunt and to compare these hemodynamic changes to those in lambs without a shunt. Moreover, we wanted to assess the influence of age on the response to sodium nitroprusside. Sodium nitroprusside was chosen because it dilates not only arterial but also venous vessels (9), which in case of a substantial left to right shunt could reduce the increased preload favorably. MATERIALS AND METHODSA total of 38 lambs of mixed breed and documented birth dates were studied. They were divided into two groups: lambs with (S) and without an aortopulmonary left to right shunt (C). Each group was split into three subgroups according to their age on the day of the study: A (1 1-26 days), B (33-52 days),...